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Is India suffering from a shortage of doctors? If so, what measures can we take to combat this issue?

Yes.There is no doubt about the fact that India has a shortage of doctors and that the doctor patient ratio is one of the lowest in the world, but more important than that is the quality of health care.Let's have a look at some figures:Now I am sure we all know that the WHO minimum prescribed limit for doctor-patient ratio is 1:1000. In India the current ratio is around 1:1700, but it is much worse in the government sector and many rural areas where it may be as low as 1:10000.These figures are quite commonly flashed by our media and also used by many of us in regular conversations as they serve as a simple means of communicating the point. But would bringing the number to the WHO standards help solve our issues?No, it won’t. And here is why:The concept of threshold of health workers was developed as part of the Joint Learning Initiative in 2004.[1][1][1][1] At that time, it was calculated that densities of 1.5 and 2.5 health work-force per 1000 population were associated with 80% coverage of measles immunization and 80% births attended by skilled health workers respectively; these two health related issues considered being the major hurdles for achieving the United Nations Millennium Development Goals.[2][2][2][2]And according to the WHO data, globally the ratio of doctors to other health workers was about 1:1.5. Based on that and keeping a ratio of 2.5:1000 for health work force, a doctor to population ratio of 1:1000 was derived and endorsed by WHO.One of the major issues with this figure is that it clubs together all doctors, whether basic (MBBS), specialists (MD,MS) or super-specialists (DM/MCh/Fellows) which is a highly flawed way of representation of the required work-force. Another issue is that we are now shifting from malnutrition and infectious diseases to non-communicable ones, courtesy Epidemiological transition. The contribution of doctors in the former category is much less than that in the latter.As an example, both measles immunization and births conducted by skilled attendants (objectives used for formulating the above ratio) are modest clinical skills and are done worldwide by nurses, midwives and paramedics.Non-communicable diseases (NCDs) (like heart disease, stroke, hypertension, diabetes, etc) are now the cause of 70% of deaths globally, ranging from 37% in low-income countries to 88% in high-income countries.[3][3][3][3] And tackling these would require more doctors, specifically specialists and super-specialists.Even the ratio of 1:1000 that we so desperately want to achieve may not be sufficient. For example, there are about 1 million fresh cancer cases diagnosed every year in India, but there are only 1500 oncologists making a ratio of 1 oncologist per 1600 patients. In the US, the ratio is 1 per 100 cancer patients and even that is considered inadequate by the American Society of Clinical Oncologists.In India, although infectious & communicable diseases and malnutrition still remain a major health issue, we are currently witnessing an epidemic of obesity, diabetes and cardiovascular disease and the projected rates show a further rapid rise in the numbers. And in my knowledge, we are not well prepared for that.Have a look at the changing trends:(Source: Institute for Health Metrics and Evaluation)You see where I am trying to get here. We need more MD/MS and DM/Mch seats than MBBS seats. Blindly increasing the number of MBBS seats, something like this (IIT-KGP medical college to offer first MBBS course by 2020-21 ) is not what we need right now. You tell me, someone in your family has diabetes; who would you rather consult for that: an MBBS doctor or a super-specialist (endocrinologist or a DM)?We don’t need more MBBS graduates who unable to get PG seats either end up buying seats or leave the country. Around 50000 MBBS doctors are produced every year in India. But only one third have the opportunity of doing a post-graduation in clinical disciplines.[4][4][4][4] If the Government does not employ resources to employ them, the chaos would continue and the profession would soon lose it’s charm.Recent opening up of AIIMS in various states, with two more upcoming is a good move by the government. Initially there were only undergraduate seats, now even post-graduation courses have been started. What is important is that the progress should continue at a reasonably fast pace without compromising on the quality of education and health care facilities.Now coming to other most important aspect: Rural India.Roughly two-thirds of our population still lives in Rural areas. According to a WHO report published in 2016, although the data is a decade older, at the national level the density of doctors of all types (allopathic, ayurvedic, unani and homeopathic) in 2001 was 80 doctors per 100,000 of the population and the density of nurses was 61 per 100,000, with the density in urban areas was 4 times the rural areas.[5][5][5][5]Quoting some direct facts from the above report:Of a total population of 1,028,610,328 in 2001, there were 2,069,540 health workers of which 819,475 (or 39.6%) were doctors, 630,406 (or 30.5%) were nurses and midwives, and 24,403 (or 1.2%) were dentists. Of all doctors, 77.2% were allopathic and 22.8% were ayurvedic, homeopathic or unani. Other categories of health workers were pharmacists, ancillary health professionals, and traditional and faith healers, who comprised 28.8% of the total health workforce.The national density of doctors was 79.7 per lakh population, of nurses and midwives 61.3 per lakh, and of dentists just 2.4 per lakh.Of all health workers, 59.2% were in urban areas, where 27.8% of the population resides, and 40.8% were in rural areas, where 72.2% of the population resides. The ratio of urban density to rural density for doctors was 3.8, for nurses and midwives 4.0, and for dentists 9.9.Among allopathic doctors, as many as 31.4% were educated only up to secondary school level – and as many as 57.3% did not have a medical qualification. Among nurses and midwives, 67.1% had education only up to secondary school level.The education level and medical qualification of urban doctors were much higher than those of rural doctors. Among allopathic doctors, 83.4% of urban doctors had higher than secondary schooling compared to 45.9% of rural doctors. Of urban allopathic doctors 58.4% had a medical qualification, whereas only 18.8% of rural allopathic doctors had one.Nationally, a greater fraction of ayurvedic doctors than allopathic doctors had more than secondary schooling: 74.8% compared to 68.6%. Homeopathic and unani doctors were slightly less well educated than allopathic doctors. Compared to 68.6% of allopathic doctors with more than secondary schooling, 66.9% of homeopathic doctors and 60.9% of unani doctors had more than secondary schooling.So what I understand from the above is that there should be much more stringent regulations for preventing our health care system from quacks. Keeping the medical registration system online updated regularly may help. People can at least check whether the doctor has a license to practice or not. I recently searched my name and I couldn't find it. (I am a licensed medical practitioner under the Delhi Medical Council)Apart from this, there is a need for better supervision of the existing colleges providing MBBS and PG degrees. How many private colleges sell seats for lakhs and crores is a fact unknown to none, but there are a lot of Government colleges and hospitals in peripheries providing dismal quality education and health-care facilities.In India, shortage of basic doctors (MBBS) is exaggerated as only 12% Primary Health Centers, the corner stone of rural health services, are without doctors. On the other hand, the rural sector is facing acute shortage of specialists with 80% per cent posts of specialists (surgeons, physicians, pediatrics, gynecologists, etc.) at the Community Health Centers, the first contact point of a villager with specialists, are lying vacant.[6][6][6][6]So there is no doubt about the fact that doctors are required to work in the rural areas. But forcing a MBBS or MD/MS graduate to work in a rural setup without any proper facilities and pay is neither justified nor would it be of any great help. The government needs to provide good infrastructure and facilities, proper living and sanitary conditions and a decent salary to doctors. An option of providing employment to the spouse (if also a doctor) in the same district or area may also be helpful. There needs to some incentive for the doctors to serve in the rural sector rather than using their education and skills to earn money and have a decent life otherwise. Also, their should be an option of taking voluntary rural postings with added incentives or pay. (Read more about this in Asher Nitin's answer to Do you think today’s young Indian doctors have chosen this profession to serve mankind or to make money? If they really wanted to serve the poor, wouldn't they accept rural postings?)In addition, there is a need to train and recruit a large number of para-medical staff (nurses, mid-wives, etc). Primary and health care workers can help in bridging the gap between our rural population without access to health-care and medical professionals. Referral system needs to be further strengthened.But the contribution of government sector to overall health care is hardly a third, while the rest two-thirds is contributed by the private setup and therefore most of the expenditure has to be borne by the public. Unfortunately the government’s way of taking care of this is putting a cap on the prices set up by the private hospitals. Dr Raghuraj S. Hegde has very well explained in his answer as to why this is not the solution.As per 2014 statistics, our Health expenditure per capita is currently 75 USD. Take a wild guess of this figure in the US. Let me tell you, it is 9403 USD. Forget US, let us compare it with a country which is at present, almost as populated as ours; China has more than five times our figure with 420 USD per capita. And not just that, while China went from 21 to 420 USD in one decade, we struggled from 16 to 75 USD in the same time.Doesn’t this make you angry? Why is our government not willing to spend more on healthcare? Or do you just plan to take out this frustration on some poor over-worked and under-paid resident doctor struggling to make ends meet in an over-burdened and under-staffed government hospital?Anyhow, in my opinion:What would help?Increase the number of post graduate seatsIncrease the number of faculty postsStringent rules to ensure that doctors work for the stipulated time in government hospitalsBuild up infrastructureBetter working environment for doctors, ensuring their safetyRecruit more paramedical staffLimit caste based reservation to only once in the family and once in the careerStrengthen the medical registry systemWhat would not help?Blindly increasing the number of MBBS seatsForcing doctors (post MBBS and post MD) to serve in rural areas.I think it's high time that our government stop romanticizing AYUSH and start focusing on the real stuff that needs to be taken care of.Thanks for the A2A User-12672574652859658938Footnotes[1] http://www.who.int/hrh/documents/JLi_hrh_report.pdf[1] http://www.who.int/hrh/documents/JLi_hrh_report.pdf[1] http://www.who.int/hrh/documents/JLi_hrh_report.pdf[1] http://www.who.int/hrh/documents/JLi_hrh_report.pdf[2] http://www.japi.org/october_2016/11_pov_time_to_revisit_recommendations.pdf[2] http://www.japi.org/october_2016/11_pov_time_to_revisit_recommendations.pdf[2] http://www.japi.org/october_2016/11_pov_time_to_revisit_recommendations.pdf[2] http://www.japi.org/october_2016/11_pov_time_to_revisit_recommendations.pdf[3] The top 10 causes of death[3] The top 10 causes of death[3] The top 10 causes of death[3] The top 10 causes of death[4] http://www.deccanchronicle.com/141115/ nation-current-affairs/article/pg-medicalseat-crunch-ails-doctors.[4] http://www.deccanchronicle.com/141115/ nation-current-affairs/article/pg-medicalseat-crunch-ails-doctors.[4] http://www.deccanchronicle.com/141115/ nation-current-affairs/article/pg-medicalseat-crunch-ails-doctors.[4] http://www.deccanchronicle.com/141115/ nation-current-affairs/article/pg-medicalseat-crunch-ails-doctors.[5] http://www.who.int/hrh/resources/16058health_workforce_India.pdf[5] http://www.who.int/hrh/resources/16058health_workforce_India.pdf[5] http://www.who.int/hrh/resources/16058health_workforce_India.pdf[5] http://www.who.int/hrh/resources/16058health_workforce_India.pdf[6] https://nrhm-mis.nic.in/Pages/RHS2015.aspx?RootFolder=%2FRURAL%20HEALTH%20STATISTICS%2F(A)RHS%20-%202015&FolderCTID=&View=%7BC50BC181-07BB-4F78-BE6F-FCE916B64253%7D[6] https://nrhm-mis.nic.in/Pages/RHS2015.aspx?RootFolder=%2FRURAL%20HEALTH%20STATISTICS%2F(A)RHS%20-%202015&FolderCTID=&View=%7BC50BC181-07BB-4F78-BE6F-FCE916B64253%7D[6] https://nrhm-mis.nic.in/Pages/RHS2015.aspx?RootFolder=%2FRURAL%20HEALTH%20STATISTICS%2F(A)RHS%20-%202015&FolderCTID=&View=%7BC50BC181-07BB-4F78-BE6F-FCE916B64253%7D[6] https://nrhm-mis.nic.in/Pages/RHS2015.aspx?RootFolder=%2FRURAL%20HEALTH%20STATISTICS%2F(A)RHS%20-%202015&FolderCTID=&View=%7BC50BC181-07BB-4F78-BE6F-FCE916B64253%7D

How can I build a real estate empire? I'm 24 years old and have $300,000 to start it off. I will be working a job until I'm 40 so from now until I'm 40 (16 years), I can also invest another $150,000 each year.

First let me start by saying congratulations, it is tremendous blessing to receive that amount of money early on a blessing not afforded to many starting-out you should be commended by seeking advice of others on how to invest it. I know at that age when I made my first lump sum of money Vegas and another like places reap the benefit of my earnings.It took me many years to understand that making money was easy, but keeping it and growing money was the difficult part.First before we start talking real estate when you advertise that you have money to invest be mindful of the mounts of advice you will receive your first lesson will be to understand that not all advise is appropriate for you or for that matter good advice at all.Understand that most advice that you will receive will either not be applicable to you or will be totally useless. So seek it vice from others who have succeeded and what it is you are trying to do. As far as building a real estate empire my first bit of advice as it pertains to real estate is to only use a percentage of that money gift it to you.Look to create a real estate company and not so much invest any portion of it directly into real estate. I say that because I understand this, that being rich and being wealthy are two totally different things. Real estate is considered wealth building which means you should not look at it as an ATM machine looking to receive money quickly on the money you invest its wealth is grown or measured over time consistently.If you're looking to generate income quickly from the percentage of the gift you received I would create a real estate company and focus on property management.I would manage the assets of others who have been successful and are seeking property managers to manage their real estate assets.I would learn from them at the same time I would continuously evolve as a skillful property manager.Why property management question?One of the main reasons is my belief that creating a property management business is much easier for an entrepreneur who is passionate about real estate. Here are a few reasons why:1. Very little out-of-pocket capital required to start a property management business2. Access to highly successful probably management business licenses/systems that are in expensive compared to other start up franchises that exists.3. The ability to become profitable very quickly4. And extremely consolable and scalable business5. Unlike real estate brokerages property management firms tend to operate with a greater level of economic stability as fees generated from management of rental properties as well as other fees generated from the business are reoccurring as such the probably management firm will be able to remain profitable despite any current housing market situation my first book by it rent it profit demonstrated this perfectly. As the book sold more copies and what was considered the downturn of The real estate market.6. Property management is one of if not the only segment of the state investing, that produces consistent income on a weekly/monthly basis. As well as a great referral system and leverage tool to participate and investment opportunities that would otherwise limit an individual's ability to participate and investments that require more upfront capital I e-moneyAnother key that has change the landscape of the property management industry is the use of use technology.technology will allow you to grow your portfolio of management properties and at the same time reduce the amount of staff that it requires to operate those rental properties.This is just a brief summary, and this comes from experience that I've personally seen employ throughout my career as a consultant in real estate. Here's a rough draft of one of my original business plan sketches hopefully you find this useful as you prepare to get started. Before you start coming to the business plan below remember what I told you, anyone can make money keeping it and allowing it to grow is the most difficult part because chances are cautious of the device you receive everyone wants to give advice to the individual who has money. Truly skillful individuals will speak to you on how to grow money not necessarily on how to or what to invest your $300,000 into always keeping in mind that being rich and being wealthy are not the same thing Rich is coming go wealth is measured over time. This is a tremendous blessing to you and your family and your future family be wise in the handling of this blessing and I wish you all the luck. Actually I take back the "good luck park".... there's no luck as an entrepreneur only hard work discipline and wisdom.>Business plan outline:(Executive summary: )Highlights:A group of highly skilled individuals in various areas of business have come together to create the next generation in property management brokerages.This group will accomplish this goal by utilizing the brand name of Bryan Chavis and his best selling book, and upcoming books to reach it a wide variety of different groups and market segments of real estate investing.The main focus of the management Business will be to focus on three types of rental investment rentals:1. Single-family2. Luxury rentals3. Midsize apartment buildingsObjectives: The first objective will be to create a procedures/operations manual to define the work that needs to be done at the brokers level then help the broker to carry out that work.Brokers work defined:1. Accounting2. Employee management "HR"3. Leadership role4. Financial goals5. Branding/marketing to obtain target client base.Management portfolio goals:1. 20 single-family homes2. 10 luxury rentals3. Five midsize apartment buildingsTotal 35 separate properties.Timeframe:Goals for listings:1. 30 single-family rental listings2. Five luxury rentals listings3. Three midsize apartment building listingsMission statement:to replace the outdated systems/organizations that currently manage rental properties and introduce owners to the future of owning operating and profiting from rental properties.Keys to success: corporate management elite level operating.1. Implement procedures/systems manuals2. Implement training, The latest online and on-site training/coaching for team members. We see a great deal of opportunity and the space eclipsing companies like, training systems are outdated.3. BrandingTeam members/technicians elite level of service:1. Implementing operating systems2. Creating training/coaching programs based on operating systems3. Marketing/branding4. Execute goals and objectives's through marketing and branding planBranding/marketing**(Description of business)Offering the future of elite property management operations, analytics, and sales(Marketing)**Action steps:1. Logo creation2. Website3. Basic marketing material4. Social media campaignTimeframe; 30 daysBook deal promotions that would lead to client opportunities "Lead generation"1. Book signings2. Free workshops/seminars both online as well as on site3. Educational services provided by TLPMA as well as its strategic partners4. Social gathering events5. Round table eventsTimeframe; we will need to set up at least a couple events within the next 30 days as well as benefit from the current schedule of events at TLPMA.CRMTimeframe; within the next 40 daysLaunch the new brand in the marketplace for the new year benefited from the promotions of the new book release as well as the new deal TLPMA educational season, as well as the academies strategic partners.Fees:Management fee @ avg 12%Application fee $25 per appLeasesing fee 45% of leaseMaintenance/administrative fees 12 % of work order completed.--------------------------------Buz wordsSystems solutionConsistency, profitabilityThe organizing function groups activities and resources so that a company can operate actively and professionally and be in economically viable enterprise. To do this, the company needs* Structure for its ownership, business alliances, and human resources;* Physical facilities, properly provisioned with communications and information systems;* Financial structure to properly manage the company's financial resources;* Policies and procedures to prescribe how business is conducted; and* Marketing and ever ties in with which to generate businessTo be used as content for the marketing section: Helpful keys for marketing your property management business:* Location, property size, rent parameters, target tenets* You're market positioning* Yo you need you need selling proposition USP what makes you different as a property management firm?* Marketing budget* Social media plan* Email marketing plan* Direct-mail plan* Network plan (associations and affiliations)* Advertising plan online, off-line, social media bloggingMarket analysis:* Strategic and market analysis* Economic outlook* Industry analysis, what we can learn from larger property management businessesContinued blessings,Bryan M. Chavis

I started learning machine learning last summer from online courses and I could apply it to simple tasks or projects such as digit recognition or recommending university courses. How can I take one step further in machine learning or AI?

Everybody is doing or did that.No one is going to applaude that you built a digit recognition system, that's the “hello world” of machine learning (ML). Just go and take a look at the TensorFlow tutorials and that's like 5 lines of code to do just that and you can easily get above 99% on MNIST digit recognition with basic models. So no one is going to be like “wow that's so cool.”Normally a lot of beginner ML courses test knowledge of students on simple problems like MNIST or a slightly more challenging one, Fashion MNIST. If that's all you did then that's not cool.Do you know what's cooler? Standing out.What is unique about your approach? Is it a novel or semi novel approach to digit recognition? Is it adversarially resistant?If you built something novel like a new ML architecture and showed that it works on digit recognition and other simple problems then that's so cool.What's also cool is to have a deeper understanding of what is going on, well, at least on the theory side of things.For instance, do you understand backpropagation algorithm and its role in ML? Can you implement it from scratch? Do you understand the role of activation functions? How does stochastic gradient descent (SGD) work?Your next move depends solely on you and the level of knowledge you acquired from those courses. Maybe it's time to apply to some internships, get involved in competitions, go for further studies or build a business.Learning ML is not just about doing online courses and calling it a day, “hey guys we good to go”, no you are not good to go. You need to consolidate a lot of knowledge by doing real world stuff because you will easily forget what you learnt in a few months or so without actual regular practice.So it's a long journey and many give up along the way.You need to keep two things in mind, growth and sustainability.As a newbie you need to grow into a professional and that means using your knowledge to solve real world problems, studying and practicing day in day out. This requires passion, tenacity and discipline. It also depends on whether you have a mentor or not, you can learn on your own but it's harder to grow that way.Sustainability means you need a form of support to keep your passion and drive going especially when it gets rough and it will. A mentor can also help out here but you can also do it on your own, though it's very difficult to do stuff on your own especially if the process require discipline. You have to control yourself and allow yourself to consistently improve without giving up.You also need money, yes, so start making money by building apps to solve problems and put them up on Google Play or App store and bring in some money for yourself. Pat yourself on the back and celebrate your small victories.Start a business and let that help to sustain your efforts through out the journey.You should consider entrepreneurship because it is very hard to break into industry using online courses or self learning without a strong network of people you can leverage for referrals and the like. It is also very hard to get a helping hand especially when you are just starting out, people will out right watch you sink. Make sure you put up measures to sustain your endeavors psychologically (motivation), financially (entrepreneurship) and spiritually (faith and hope).Personally I set things up such that I have some businesses to help out on the financial side in order to allow myself to pursue ever more challenging ML projects and then I try to monetize my research by building apps and the apps in turn bring in more money, that motivates me to further research and develop better algorithms and the circle repeats.See, aim for self sufficiency, I do my own independent research and run my own businesses. So I can take as much time as I want learning ML and build sophisticated projects along the way.We all have unique experiences find your own path and be proud of it.Hope this helps.

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